Quantifying the Health Impacts of an Unjust Food System

If you ask many people what they think of when they think of Detroit, and a common answer would likely be violent crime. Seemingly every evening the local news reports the number of people dead in the latest deadly crime to occur in Detroit and encourages local residents to call the police with any information. The next day, there is usually a press conference held by the Detroit police department promising justice and asking local residents to step up. Lastly, there may be an editorial in the News expressing the general point that if only Detroiters would stand up and say enough is enough in regards to violent crime the City’s problems would be solved and its renaissance would finally come to be. While the stories surrounding violent crime are often jarring which likely explains why they are given so much attention by both our media and our government, the truth is that Detroit’s most prevalent killer is not violent criminals by the food system.

According to the Michigan Department of Health and Human Services, 3,163 of Detroit’s residents died from heart disease or diabetes in 2013. Those 3,163 deaths accounted for 43% of the City’s total number of deaths that year. In contrast, 291 of Detroit’s residents were killed in a homicide. Heart disease is also the leading cause of hospitalization in Detroit as approximately 13,000 Detroiters are hospitalized every year for a heart-related condition. Not surprisingly, the rate of hospitalization for heart-related conditions in Detroit is approximately 25% higher than the state average. All of this is to say that if you’re a Detroiter, it’s more likely that you will be hospitalized and/or die from an unhealthy diet than a gun. Considering that medical bills are the leading cause of bankruptcy, diet-related hospitalizations will likely drain family resources until they are non-existent. Diet-related deaths will often rob communities and families of stabilizing forces leaving those that remain to fill the void on both a social and financial level.

However, the negative impacts of an unhealthy diet don’t stop at the individual level. All of those hospitalizations place a heavy burden on federal, state, and local government institutions. The loss of life due to diet-related conditions also comes with a heavy financial loss. According to the Michigan Department of Health and Human Services, the City of Detroit lost a collective 19,797 years of life amongst its residents due to premature death caused by heart disease. Even one endorses the $50,0000 valuation for a year of quality life that is commonly utilized by health insurance companies (and which has been criticized as being far too low), Detroit is collectively losing approximately $990 million each year in connection with premature deaths caused by heart disease. If the valuation of a year of quality life is increased to $129,000 based on a recent study by Stanford economists, the collective financial loss soars to over $300 trillion.

This is not to say that violent crime is an unimportant problem in Detroit; violent crime obviously has a ripple effect on the friends and family of those involved and on the surrounding community that is very difficult to quantify. It is simply meant to put things into perspective. Detroit is consistently ranked as one of the countries most unhealthy cities by national surveys. In the Gallup-Healthways Well Being Index, Detroit was 79th out of 100 in the 2014 comunity obesity ranking. In the American Fitness Index, Detroit ranked 43rd out of 50. No matter how you cut it, Detroit is an unhealthy city that it is having an enormous impact on its residents, its communities, and the city as a whole. The 2015-2016 budget for the City of Detroit allocates $315 million to the police department and only $33 million to the Department of Health and Wellness Promotion. Given the fact that diet-related illnesses are the leading cause of death in Detroit, it is at least worth thinking about how the City can better allocate its funds to save the lives of more of its residents.

At this point, it’s important to mention that a silver bullet for preventing things like heart disease and diabetes does not exist. While we know that both are health conditions that are closely tied to a poor diet and inactive lifestyle, promoting a healthy diet and an inactive lifestyle is a complex undertaking that involves several variables. In regards to diet, there are issues regarding locational access, financial access, cultural compatibility, and diet and cooking education. We do know is that eating a diet high in fruits and vegetables is a good start towards reducing a person’s risk of heart disease or diabetes. We also know that numerous studies have found there to be a consistent positive association between proximity to supermarkets and health food stores that regularly stock fresh fruits and vegetables and diet patterns and weight status. However, diet is only part of the problem. Studies have also shown that low-income communities typically lack physical activity facilities such as parks and increasingly studies are starting to examine how the built environment contributes to heart disease and diabetes amongst low-income communities. There is also the issue of food culture and habit. Between 1977 and 1995, the number of meals or snakes eaten at fast food restaurants has increased by 200%. The increase in fast food consumption has been has also been especially prevalent amongst children as many fast food retailers have purposefully sited restaurants within walking distance of schools. All of this is to say that modern day children, particularly low-income children, are more likely to grow up with fast food being a focal point of their diet which will likely impact their food choices as adults.

The complexity of the problem should be of no surprise given the complexity of the food system. There is also the issue that, at the end of the day, what a person decides to eat is a very personal choice. However, potential solutions at many different levels of government are being implemented. At the federal level, President Obama signed the Healthy, Hunger-Free Kids Act in 2010 which sought to make school meals healthier. However, several cities are taking the lead on this issue. Initiatives vary widely, but have included increasing food and diet related curriculum in schools, limiting fast food restaurant sitings around schools through zoning restrictions, encouraging local food production, and promoting educational programs that teach people how to eat healthy.

These initiatives have not come out of nowhere and typically have been a result of cities expanding their health departments to confront the public health crisis that is caused by diet-related illnesses. For example, Baltimore, Louisville, and New York City all have hired a food policy director to support the work of governmental and non-governmental organizations seeking to create a more just and healthy food system and to coordinate city resources as necessary. Given the enormous costs Detroit and its residents have to bear in regards to diet-related health issues, Detroit stands to greatly benefit from investing resources in programs and individuals who are seeking to ensure that healthy fruits and vegetables are accessible to all Detroiters in regards to both price and location. A great first step would be hiring a food policy director.